Indications: primary hypercholesterolaemia (type IIa including heterozygous familial hypercholesterolaemia), mixed dyslipidaemia (type IIb), or homozygous familial hypercholesterolaemia in patients who have not responded adequately to diet and other appropriate measures; prevention of cardiovascular events in patients at high risk of a first cardiovascular event.

Cautions: same as other statins, patients of Asian origin (see under dose); patients with risk factors for myopathy or rhabdomyolysis, including personal or family history of muscular disorders or toxicity (see under dose).

Hepatic impairment: Statins should be used with caution in those with a history of liver disease and avoided in active liver disease or when there are unexplained persistent elevations in serum transaminases.

Renal impairment: initially 5 mg once daily (do not exceed 20 mg daily) if eGFR 30–60 ml/minute/1.73 m2; avoid if eGFR less than 30 ml/minute/1.73 m2

Side Effects: same as other statins also proteinuria; very rarely gynaecomastia, haematuria; also reported oedema, Stevens-Johnson syndrome

Dose: Hypercholesterolaemia, initially 5–10 mg once daily increased if necessary at intervals of at least 4 weeks to 20 mg once daily, increased after further 4 weeks to 40 mg daily only in severe hypercholesterolaemia with high cardiovascular risk and under specialist supervision; ELDERLY over 70 years, initially 5 mg once daily; patient of ASIAN origin or with risk factors for myopathy or rhabdomyolysis, initially 5 mg once daily increased if necessary to max. 20 mg daily Prevention of cardiovascular events, 20 mg once daily; ELDERLY over 70 years, patient of ASIAN origin or with risk factors for myopathy or rhabdomyolysis, initially 5 mg once daily increased if necessary to max. 20 mg daily

Note: Initially 5 mg once daily with concomitant fibrate increased if necessary to max. 20 mg daily.